Upper abdominal pain on the right


In medicine, the abdomen is divided into four quadrants, drawing a vertical and a horizontal line through the umbilical region. The upper abdomen is thus divided into the right and left upper abdomen. The Epigastric region (Epigastrium), in the middle upper abdomen, considered separately. It should be noted that the localization of the pain cannot always be used to determine the cause, as in some diseases the pain radiates and each patient perceives pain differently.


Right-sided upper abdominal pain is understood to mean permanent or colicky pain in the area of right upper abdomen. Upper abdominal pain is often reported by patients. They can have very different causes.


Next to the Small intestine ulcer can also have other intestinal disorders, such as Inflammation and InfectionsTo be cause of right upper abdominal pain. If the pain in the right upper abdomen persists, you always have to Colon cancer be considered. Colon cancer is a malignant one Tumor disease of Intestines. The most common tumor disease is im Large intestine localized, but in principle it can occur in all parts of the intestine.
Colon cancer is after Breast cancer (with women) and Prostate cancer (with men) the second most common tumor disease. Colon cancer often develops on the base of benign protuberances in the intestinal wall, the so-called Polyps, which is part of a Colonoscopy can be recognized and removed. If you do not remove the polyp, it can lead to various genetic changes uncontrolled growth and to develop a malicious one Tumor come. Other factors can promote the development of a malignant tumor. Which includes Obesity, Smoke, wrong diet, as well as a Family stress with cancers.
In many cases that happens development to the malignant tumor very much slowlyso that the typical complaints can be absent. These include Blood in the stool, persistent upper abdominal pain or cramps, changed bowel habits, as well as inexplicable in later stages Weight loss, fatigue and Exhaustion.
To diagnose cancer of the bowel, a test for blood in the stool is used Palpation examination of the abdomen and one Colonoscopy.
The therapy of the Colon cancer includes a surgical removal of the tumor and possibly a Rays- and or chemotherapy. The earlier the tumor is discovered and the easier it is to remove the tumor during surgery, the better the prognosis.

Another disease of the liverwhich can cause upper abdominal pain right is the Cirrhosis of the liver. In liver cirrhosis, the liver is remodeled with connective tissue because the healthy liver cells perish. The damage to the liver cells can be caused by various liver diseases, such as the hepatitis and the Fatty liver or, less often, be caused by congenital liver disease. Destruction of the liver cells through excessive use is also very common Alcohol consumption. The symptoms of cirrhosis of the liver can be very variable and range from itching, fatigue, Exhaustion, Bloating and Upper abdominal pain right up to confusion with hepatic coma. Due to the connective tissue remodeling of the liver, this can be seen in the physical examination hardened Keys. Also one Ultrasound examination of the abdomen, various Laboratory tests and a detailed questioning of the person affected by the doctor can lead to the diagnosis.
The therapy of liver cirrhosis depends on the cause and ultimately consists of the Avoidance of liver damaging substancessuch as alcohol or medication. Cirrhosis of the liver can only be cured with one Liver transplant. Furthermore, many organs that are not located in the upper right abdomen can still cause pain on the right upper abdomen. These include, for example stomach and the pancreaswhich are more likely to be in the left upper abdomen, but in the event of an illness can cause the pain to radiate to the right upper abdomen. Furthermore, structures outside the abdominal cavity, such as the diaphragm, the heart and the Spine, show pathological changes, which are also expressed in upper abdominal pain on the right.

Illustration of right side abdominal pain

Illustration of the right abdominal cavity
  1. Liver - Hepar
  2. Gallbladder -
    Vesica biliaris
  3. Stomach - Guest
  4. Large intestine, transverse part -
    Transverse colon
  5. Small intestine -
    Intestine tenue
  6. Colon, ascending part -
    Ascending colon
  7. Appendix - Caecum
  8. Appendix -
    Appendix vermiformis
  9. Fallopian tubes - Tuba uterina
  10. Ovary - Ovary
  11. Uterus - uterus

You can find an overview of all Dr-Gumpert images at: medical illustrations

Right upper abdominal pain when coughing

Upper abdominal pain that is right sided and only when coughing occur are mostly muscular-related. If there were organic causes, the pain would mostly be permanent. Since numerous muscles are stretched between the ribs, the coughing can lead to a kind of straining of the muscles, in this case in the area of ​​the right upper abdomen, which then leads to pain, especially when coughing. Important would still be up Concomitant symptoms, how Shortness of breath, fever etc. to pay attention, which would then rather speak against a muscular cause.


Upper abdominal pain right can with nausea accompanied. Nausea is a negative sensation that manifests itself as being unwell and feeling like vomiting.
Depending on the type of underlying disease, nausea can be accompanied by other complaints, such as Vomit, Diarrhea, a headache, Eye pain, dizziness, fever and to cough accompanied.
After recording poisonous or spoiled food the nausea serves as Protective function of the body to get rid of the harmful food and is often associated with vomiting and upper abdominal pain.
However, nausea can also appear as a symptom of pathological processes. This includes Diseases of the abdominal organs (Stomach, intestines, pancreas, gallbladder and liver), Infectious diseases, Diseases or injuries of the Brain (concussion, Sunstroke or migraine), Diseases of the inner ear and mental illness.

Also can Medication, Food intolerance and Food allergies, as well as the excessive consumption of alcohol, Be a trigger for nausea with or without vomiting.
In women, nausea is also during the early phase pregnancy possible.

Read more about this at: Nausea in pregnancy

First there is a detailed questioning by the doctor. Important questions are when exactly the nausea occurs, whether it occurs in connection with eating, which symptoms accompany the nausea (Vomiting, diarrhea, upper abdominal pain, headache, dizziness, fever) and whether diseases that cause nausea have been identified before.

This is followed by a physical examinationat which the belly bugged and scanned becomes. Often the diagnosis can then be made. In addition, a Ultrasound examination of the abdomen, an examination of blood and urine of the person concerned, a Gastroscopy and a Computed Tomography (CT) of the head.
Various measures can be considered for treating nausea. The focus is on Treatment of the underlying disease.

If the nausea is due to food intolerance or the excessive consumption of food and luxury foods, one is sufficient in most cases Change of diet, a feeding break, as well as the Renunciation of luxury foods (alcohol).
Nausea medication

Nausea medication will too Antiemetics called. In the case of nausea with severe vomiting, admission to the hospital may be necessary to deal with the severe loss of salt and water Infusions balance.

After eating

Occur epigastric pain after eating there are numerous possible causes. For one, can Diseases of Stomach, of Small intestine and the Gallbladder (see above on the main page) lead to upper abdominal pain after eating.
On the other hand, upper abdominal pain is often through after eating wrong diet, Food intolerances and -allergies conditionally. Foods that often cause upper abdominal pain after eating are flatulent foods, such as legumes, bulbs, and cabbage. These foods lead to one increased gas formation in the stomach or intestines, which can lead to upper abdominal pain after eating. Also very fatty foods can trigger upper abdominal pain immediately after eating.
But not only the food itself, but also the way in which the food is supplied plays a role in the development of upper abdominal pain. Care should always be taken do not eat too large quantities in a hectic pace. Furthermore, it is sufficient Drinking amount to be careful to avoid constipation and an uncomfortable feeling of fullness with upper abdominal pain after eating. Some foods can cause intolerance reactions in some people, which, in addition to upper abdominal pain after ingesting the food, often also result in symptoms such as nausea, Vomit and Diarrhea express. Examples are the Lactose intolerance, in which lactose cannot be tolerated due to an enzyme deficiency, or the Fructose intolerancein which fructose cannot be tolerated due to the lack of a transporter in the intestinal wall. Finds an intolerance reaction after ingesting one toxic food (poisonous plants, bacterial toxins in raw foods) instead, one speaks of a Food poisoning. The food poisoning can cause severe upper abdominal pain, nausea, vomiting and diarrhea, too Seizures and Hallucinations cause. The Food allergy is a hypersensitivity reaction to certain foods and thus a special form of food intolerance. After ingesting the food, an allergic reaction occurs with symptoms such as itching and Swelling of the skin and mucous membranes, thereby possibly narrowing the bronchi with shortness of breath, as well as severe upper abdominal pain with nausea, vomiting and diarrhea. For example, allergies to peanuts are widespread. The best therapy in these cases consists of avoiding the food that triggers the intolerance reaction or the allergic reaction. Solve diseases of the Stomach, of Small intestine and the Gallbladder the upper abdominal pain after eating, the focus is on treating it.

Upper abdominal pain with flatulence

Upper abdominal pain right can with Flatulence be socialized. Flatulence is uncomfortable Air accumulation in the stomach that can arise when a person Air swallows or if there is a reinforced Formation of gases comes in the stomach.
Flatulence can come in a cumulative finish Intestinal gases express what one calls flatulence designated. If the gases cannot escape, a Bloated stomach come what one as Meteorism designated. Usually there are flatulence not dangerous and only wrong nutrition, hectic food intake or Food intolerance traced back.

However, different Diseases of the gastrointestinal tract, of the Gallbladder, of the liver and the pancreas lead to excessive formation of gases, which is why persistent flatulence should be clarified by a doctor. Flatulence can be associated with various other complaints, such as Vomit, Abdominal cramps, Diarrhea, or with constipation.
Are common flatulent foodsHow legumes, cabbage and bulbous plants trigger the development of the unpleasant gas. Carbonated drinks also have a flatulence effect on the body Intestines. Furthermore, hectic feeding of food and through stress Flatulence is encouraged. Another major cause of gas is food intolerance. An important example is that Lactose intolerance. The flatulence is often accompanied by severe pain in the upper abdomen and diarrhea.
Flatulence can also be due to over- or over-colonization of the intestine bacteria arise, or due to an infection with fungi. You can also use various drugs, especially Antibiotics, Cause flatulence.
In the case of persistent flatulence, which is accompanied by severe upper abdominal pain and other complaints, you always have to Diseases of the gastrointestinal tract, gallbladder, liver and pancreas.

In order to determine the cause of the flatulence, the person concerned is questioned in detail by the doctor. It is important to ask about other complaints, such as upper abdominal pain, diarrhea or constipation, about previous illnesses that could be responsible for the flatulence and about medications that the person concerned takes regularly. This is followed by a physical examination With Wiretapping and Scan of the abdomen.
Other tests that are useful in determining the cause include tests for food intolerance, Investigations from blood, chair and urine of the person affected, an ultrasound examination of the abdomen and, if necessary, an X-ray examination.
The therapy depends on the cause of the flatulence. The focus is on Treatment of the underlying disease. If there are no diseases of the abdominal organs, it is often sufficient to avoid gas and flatulence Avoiding Foodwhich cause intolerance reactions. Nutritional advice can be obtained. Medicines that are used to treat flatulence are for example Antispasmodics (antispasmodic effect), Defoamer (lead to the breakdown of gas bubbles) and Carminatives (herbal remedies with antispasmodic properties).

Inflammation of the gallbladder and gallstones

In the area of ​​the right upper abdomen is the Gallbladder with its bile ducts settled. Quite often it comes from you Gallstonethat is either in the gallbladder or has come loose and drifting through the ducts, leading to right-sided upper abdominal pain. Once a gallstone has become detached and is swimming through the narrow bile ducts, it can get stuck in a tight spot, which in turn can lead to very severe and colicky pain.

Furthermore, inflammation of the gallbladder, whether chronic or acute, can lead to right-sided upper abdominal pain. Gallbladder infections sometimes occur as a result of gallstones in the gallbladder.

  • Inflammation of the gallbladder, usually due to the build-up of bile in the gallbladder due to a Gallstone
  • Abdominal pain in the area of ​​the right upper abdomen, the pain is common colicky (alternating and increasing)

  • Risk factors for the development of gallstones: female gender, light skin color, overweight, older than 40 years, of child-bearing age, already own children

  • Diagnosis through Ultrasound examination of the abdomen, certain laboratory parameters and possibly security by a ERCP (= Representation of the biliary tract as part of a gastrointestinal mirror)

  • therapy: In the acute phase you should Painkiller and Antibiotics are given. Later on, surgical removal of the gallbladder is recommended (Cholecystectomy).

  • Complications: Accumulation of pus in the gallbladder, rupture of the gallbladder with emptying of the bile into the abdomen

Diagnosis if gallstone problems are suspected

To clarify the cause of gallbladder inflammation, above all, is the Patient survey and the physical examination very important. The doctor will ask the patient about eating and bowel habits, the severity of the symptoms and first appearance, as well as known gallstones.

The epigastric pain especially occurs after eating fatty foods on, this already indicates a Gallbladder or gallstone problem down. This is followed by the physical examination, during which the abdomen of the lying patient is first listened to in order to assess the intestinal noises and then palpated to find out pain-causing points. The so-called Murphy test is also suitable for diagnosing gallbladder inflammation, in which the patient is asked to first exhale completely and then inhale deeply. During this inhalation maneuver, the examiner presses on the area under the right costal arch. If the patient feels severe pain at this point when inhaling, this indicates a gallbladder infection. The proving diagnosis is then carried out by means of a Ultrasound examination posed. Any gallstones that may be present appear white, an inflamed gallbladder may also appear with a three-layered gallbladder wall. If there are any doubts about the ultrasound and physical exam, one can Blood test show inflammation in the gallbladder area. Inflammation values ​​such as CRP or leukocytes would then be significantly increased.

Gallstones, which only occasionally cause discomfort, do not require treatment. It should be noted that symptomatic gallstones in the gallbladder can also lead to painful colic at some point. A gallbladder inflammation or pain symptoms permanently triggered by gallstones must be treated in any case. In the past one tried to dissolve the stones with medication, today the removal of the gallbladder is the treatment of choice. The operation is carried out endoscopically, i.e. using the gentle keyhole technique.

Small intestine ulcer

  • ulcer in the small intestine (mostly in the duodenum) with defects in the lining of the intestine

  • Abdominal pain especially in the right upper abdomen, the sober and at night are particularly strong and lose weight with food.

  • Diagnosis by a Gastrointestinal reflex

  • therapy: Acid blockers, Change in diet (no roasted substances, no spicy food), Smoking cessation

  • Complications: Bleeding from the mucosal defect, breakthrough of the stomach wall with emptying of the stomach contents into the abdominal cavity

Liver disease

  • e.g. Inflammation (hepatitis), thrombosis (Blood clots) or swelling due to backlog of blood (e.g. with heart disease)

  • Increase in waist circumference, possibly Yellowing of the skin, Loss of appetite, and much more.

  • Diagnosis through increased liver values in the blood (liver enzymes, bilirubin), Ultrasound examination of the abdomen, possibly taking samples of liver tissue for microscopic examination.

  • therapy: Depending on the cause, liver diseases can be treated with medication. However, surgical or minimally invasive interventions are sometimes necessary.

  • Complications: Hepatic coma by accumulation of toxins that are normally broken down by the liver.

Pain radiates to the back

Right-sided upper abdominal pain, which also pulls in the back, can also always come from one inflamed pancreas come. This very serious clinical picture comes from either excessive alcohol consumption or a gallbladder stone that has got stuck in a hallway. Typical of a pancreatitis (Pancreatitis) is the belly- and belt-shaped pain that pulls into the back. The diagnosis is carried out by ultrasound and blood tests.

Upper abdominal pain during pregnancy

Upper abdominal pain on the right side can also occur during pregnancy. On the one hand, all diseases that also cause upper abdominal pain in the non-pregnant woman (for example diseases of the Gallbladder, of the liver and des Gastrointestinal tract) can also be the reason for this during pregnancy.

On the other hand, clinical pictures can be responsible for the upper abdominal pain, which typically only occurs in pregnant women and as Gestures be summarized.
An important example of a gestosis, which can be associated with upper abdominal pain on the right, is the so-called Hyperemesis gravidarum. Hyperemesis gravidarum is a severe form of Pregnancy sicknesswhich is strong and persistent Vomit, Upper abdominal pain and Dizzy spells comes. How exactly the hyperemesis gravidarum develops is unclear. The pregnant woman loses from the excessive vomiting Salts and liquidcausing it to dehydration and Circulatory weakness can come. In many cases, the patient has to be admitted to a hospital to prevent further loss of salts and fluids with the help of the administration of Infusions to prevent. If the administration of infusions is insufficient, the pregnant woman can use Medication which suppress the nausea and the urge to vomit.
These drugs are called Antiemetics, an important representative is the so-called Ondansetron. The prognosis for hypermesis gravidarum is good.

Another example of a gestosis, which can be the basis of upper abdominal pain right during pregnancy, is the so-called HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets). The cause of the development of the HELLP syndrome has not yet been conclusively clarified, but it is suspected that processes in the placenta (Plaster cake) involved.
With the affected person it comes to one Breakdown of red blood cells (Hemolysis), to a Liver damage with increasing Liver enzymes (Elevated Liver Enzymes) and to one Drop in platelets (Low platelets), resulting in complaints such as right upper abdominal pain, nausea and vomiting, a headache and Eye flicker can express.
The HELLP syndrome is for pregnant women potentially life threatening, which is why right upper abdominal pain during pregnancy should always be interpreted as a warning signal and should be clarified by the doctor. Treatment for HELLP syndrome consists of one immediate delivery of the child, since processes in the placenta are discussed as the cause of the development of the HELLP syndrome.

Upper abdominal pain on the right at night

Upper abdominal pain that exclusively at night occur, presumably have no purely organic cause, otherwise the pain would also be present during the day. Nonetheless, should Eating habits be reconsidered, because abdominal pain (even at night) can always occur after eating high-fat food late. This would then also apply to a Gallbladder involvement speak. It is also important to ask whether the pain occurs every night and how long it lasts. A treatment attempt with a hot water bottle should only be undertaken cautiously, as this could aggravate a gallbladder problem.